Why I Do Therapy and Medication
Many psychiatrists don't do therapy anymore. That's not a secret. Somewhere along the way, psychiatry became a 10-minute medication check, and therapy got handed off to someone else.
There are many reasons for this - mainly the insurance model and high-throughput clinics trying to optimize at the expense of presence in care.
I chose differently.
During my residency training (that's four years of psychiatry-specific work and learning after medical school), in addition to our program's basic therapy requirements, I often sought out additional training. TEAM-CBT on Tuesday nights after a full day of work. Attending DBT groups while at Women's Trauma Residential. A CBTi overview while rotating at the student health center. None of it was required. But I felt that my aim was to learn the depth and breadth of the different ways people can be helped, grow, and improve their lives. Medication is but one tool in the tool bag.
When I finished my residency at Stanford in 2021, I knew I wanted to do both. Because it doesn't make sense to me to prescribe something without understanding the person I'm prescribing it to. And it doesn't make sense to do deep therapeutic work without understanding the biology underneath it.
So that's what I do often, if it’s right for the both of us. I work with people in ongoing psychotherapy. Real therapy, not just "how are the meds going?" (Also, that works totally fine for some people!)
And I manage medication when it's appropriate. When we’re working mainly with meds (which always includes thinking about lifestyle and overall life), sometimes "how are the meds going?" really is the main idea - though I always want to know about the rest of your life for context. Not sleeping, eating, or exercising? In the middle of the worst divorce ever? Meds might help, but they'll only do so much against those forces.
Sometimes someone comes to me thinking they need a prescription, and what they actually need is space to think. Sometimes it's the reverse. Sometimes it's both.
What This Actually Looks Like
A typical session with me is 50 minutes. We talk. I listen carefully. I'm tracking what you're saying, but I'm also tracking what's happening underneath - your nervous system, your patterns, the way you talk about yourself, what you might be avoiding. I pay attention to your eyes (brainspotting!). I'm not watching you like a falcon hawk staring contest. I'm trying my best to be present and attuned. I'm even using a little intuition, that tiny "voice" in my brain and body.
A topic for another time, but: Attunement heals.
Across modalities. I believe in this deeply.
I'm trained in TEAM-CBT, which is a structured, evidence-based psychotherapy. As well as psychodynamic therapy, which looks at how our past affects our present and how our minds affect us in ways we don’t even always realize. I also use brainspotting, which is more somatic, flowing, and relational - it works on the deep emotional level where your body holds things (and where psychedelic work, dreams, art, and altered states all live). Depending on what we're working on, I draw from other modalities too.
As Dr. K says: a good therapist knows what not to apply to the person in front of them. Deep personalization is key.
Unfortunately, what that means is I wish I could give you a formula. We'll do X, Y, Z, and have you in tip-top shape in three weeks, guaranteed! That would be awesome. And you know, there are courses and educational materials for that - which I can refer you to. Some people need and prefer a more regimented style, and if that's you, we can work from a more traditional CBT model, a workbook together, or I can connect you with someone who's a little more by-the-book.
But what I do is weave in strands and threads from everything I've learned, sensing what might be most helpful for you in the moment. With relationship and attunement above all else - because we know that's what matters most.
Medication is a tool. A good one, sometimes. But it's not an identity, and it's not a substitute for understanding yourself and deep healing.
(That said, sometimes someone just needs to be on something for years, decades, or life - and as long as we're careful about the pros and cons, that is okay too.)
Who This Is For
Most of my patients are juggling multiple things in their lives well. They're smart. They're running businesses, creating, coding, leading. Doing well by external measures, and their resumes often look solid. But something's off - maybe it's been off for a while. Maybe shit has hit the fan, or it's the first time they've taken enough of a breather to notice.
Maybe you've been in therapy before and it was fine but not deep enough, not relational enough (I'll try my best). Maybe you've seen a psychiatrist who spent 10 minutes with you and wrote a prescription. Or you told them you stayed up all night one time in your twenties and got slapped with a bipolar diagnosis faster than you could say, "But also, I had none of the other associated symptoms you just said would actually make it bipolar!" Or maybe they didn't even stop to ask. Maybe you've been managing on your own and you're tired of managing.
You don't need someone to tell you what to do. You need someone who can think with you. Someone who understands both the science and the person sitting in front of them.
That's what I'm here for.
Why This Matters
There's good evidence that the therapeutic relationship is one of the strongest predictors of outcome in mental health treatment. Not the specific modality (though your buy-in and loving it is important too, and there is a role for method). Not the medication. The relationship.
Attunement heals.
Dr. Patricia Pop is a board-certified psychiatrist offering psychotherapy and medication management via telehealth throughout California. She is based on the coast in Half Moon Bay.